NUR81028:

INTRODUCTION DISASTER LEC

Prof. Margaret Natividad | January 2023 2nd Semester

○Those caused by natural or environmental

DISASTER NURSING
forces
DISASTER
○ Result of ecological disruption of threat that
● Serious disruption of community/societal
exceeds the adjustment capacity of the
functioning at any scale due to hazardous events
affected community (WHO by Lechat, 1979)
interacting with conditions of exposure, vulnerability
○ Consequence of intersection of a natural
and capacity, leading to one or more of the
hazard and human activity
following:
■ Examples: earthquakes, floods, tornadoes,
○ Human, material, economic, and
typhoons/hurricanes, volcanic eruptions,
environmental losses and impacts
tsunamis, ice storms, and other
■ According to United nations international
geological or meteorological phenomena
strategy for disaster reduction (UNISDAR),
● Man-made or Anthropogenic
2017
○ Human generated disasters
○ Ex: Earthquake that can lead to human losses
○ Principal direct causes are identifiable human
and property destruction
actions, deliberate or otherwise (Jah, 2010)
● Ecological disruption, or emergency of a severity and
○ Examples: biological and biochemical terrorism,
magnitude that result in deaths , injuries, illness, and
chemical spills, radiological (nuclear) events,
property damage that cannot be effectively
fire, explosion, transportation accidents armed
managed using routine procedures or resources,
conflicts, and acts of war
and that require outside assistance
■ Bioterrorism: people experiment on
○ We try to be ready and we can prepare
viruses then attack on human beings
materials for coming disaster
■ Chemical spills: place it in different
○ To prepare disasters like Typhoons (storm
containers to create disaster → kill people
surge)- determined through forecasts
■ Radiological events: uses nuclear to kill
and harm people
HEALTH DISASTER
■ Acts of war: fire
● Catastrophic events that results in
○ Casualties that overwhelm the healthcare HUMAN GENERATED DISASTERS
resources on that community (Al-Madhari &
● Complex emergencies
Keller, 1997)
○ Situations where populations suffer significant
■ Inadequate facilities, nurses are
casualties as a result of war, civil strife to other
unprepared
political conflict
○ And may result in a sudden unanticipated
■ In many countries there are varied
surge of patients (Institute of Medicine (IOM,
conflicts that leads to significant
2015)
casualties
■ Occurence of viruses, nurses are not
○ Disasters are the result of combination of forces
prepared
such as drought, famine, disease and political
○ A change on standards of care (IOM, 2009)
unrest that displace millions of people from
■ Prepare the PPE’s needed
their homes
○ A need to allocate scarce resources (IOM, 2012)
○ Ex. humanitarian disasters, civilian fleeing
■ No one was prepared for COVID-19
genocide, refuges displace by conflicts
■ Vaccines were lacking
■ Many countries have different political
conflicts
DISASTER NURSING
■ Ex: people do not want their politicians in
● An adaptation of professional nursing skills in their place → they cause their own
recognizing and meeting the nursing physical and disasters
emotional needs resulting from the disaster ● Technological disasters
○ Emotional and behavioral needs of those who ○ Large number of people, property, community,
are affected including the healthcare team infrastructure, and economic welfare are
○ We need to study the different variants that are directly and adversely affected by major
arising industrial accidents unplanned release of
■ Ex: superbug infections, COVID-19 -DELTA nuclear energy, and fire or explosions from
etc. hazardous substances (fuel, chemicals, or
nuclear materials)
BROAD CLASSIFICATION OF DISASTERS ■ Nuclear energy - radio isotopes
● Natural disaster

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 ○ Natural & human made disaster trigger each ○ Different countries have different kinds of
other → secondary disaster (synergistic disasters
disasters)
■ Example: Earthquake → can cause HAZARD VS RISK IN DISASTER
chemical plant explosion ● Hazard (cause)
■ Ex: Tornadoes → explosions ○ Potential threats to humans and their welfare
■ Secondary disasters caused by that ○ Possibility of occurrence of a disaster caused
original disaster by natural phenomenon, failure of man-made
● Synergistic disasters source of energy or human activity
○ NA-TeECHS (natural and technological ● Risk
disasters) ○ Actual exposure of something of human value
○ Natural & Human made disaster trigger each and is often measured as the product of
other → secondary disaster (synergistic probability and loss
disasters) ○ Ex: what are the risks associated with: floods,
■ One disaster leading to another disaster tornadoes, radiation?
■ Ex: earthquake → chemical plant
explosion HOSPITAL/ HEALTH CARE FACILITY DISASTER TYPES
● Disasters are not caused by natural hazards but ● Internal
occur in human settlements ○ Cause disruption of normal hospital function
due to injuries of hospital personnel or damage
DISASTERS to the facility itself (hospital fire, power failure,
● Categorized based on chemical spill)
○ Onset ■ Affects the function of the whole hospital,
■ Rapid personnel, which affects the care of the pt
■ Gradual / Chronic (creeping disasters) ■ Ex: Power failure → those who will suffer
○ Impact are people with mechanical ventilation,
■ Sudden/Rapid pts in the OR that is why we have back-up
● Ex: earthquake, storm surge, flash generator
floods when the community is ● External
unprepared ○ Do not affect hospital infrastructure but tax
■ Prolonged hospital resources due to number of patients or
● Nuclear weapon type of injuries
● Radiation - burns → alteration of the ■ Ex: just like what happened due to covid
cell → cancers → cause loss of lives time
○ Duration
HEALTH EFFECTS OF DISASTER
FACTORS THAT INFLUENCE IMPACT OF DISASTER ● Cause premature deaths, illnesses, and injuries
ON COMMUNITY ○ In the affected community, generally exceeding
● Nature of event the capacity of the local health care system
○ Depends on the signal number of the typhoon ■ Ex: Earthquake in Tacloban City → due to
○ Depends on the preparedness of the lack of resources
community ● Destroy the local health care infrastructure
○ Signal 1: no classes because this can cause ○ Unable to respond to the emergency
flood already ■ Government and healthcare workers are
● Time of the day or Year also affected (synergistic disaster)
○ Ex: Winter season - may cause ice storms → ○ Long-term consequences in health outcomes
people may freeze to death in terms of increased morbidity and mortality
■ Ex: Countries like Canada ● Create environmental imbalances, increasing the
○ Ex: heatstroke during summer time risk of communicable diseases and environmental
● Health and age characteristics of population hazard
affected ○ Ex: COVID → vans serve as morgues → unable
○ Young and elderly are more vulnerable to provide morgues due to the many number of
○ Elderly are commonly affected but they can morbidity
adjust ● Affect the psychological, emotional, and social
● Availability of resources well-being of the population in the affected
○ For coming disaster we always have forecast to community
prevent loss of lives and properties ○ Not only those members of community are
● Location affected but also the healthcare team in all
○ Specific locations (Manila etc.) and Specific aspects of well-being
disasters

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 ○ We have to be strong that is why we have our ○ November 4, 1991
orientation and psychological counseling ○ 5000-8000 killed
○ We cannot give what we do not have ○ 3000 missing
○ We have to be stable during disasters but ○ Visayas
sometimes we cannot help it, we become ● Mayon Volcano eruption (Feb 1, 1814)
affected and that is part of training ○ Most violent volcanic eruption
● Cause shortages of food and cause severe ○ 1200 killed
nutritional deficiencies ● Bagyong Yolanda
○ Leading to diseases ○ September 8, 2013
○ Young and elderly are mostly affected ○ 315 kms/her
○ Schools became temporary shelters of the ○ Supertyphoon
people ○ No water and food
○ Communicable diseases take effect in these ○ Stormsurge caused the death of the filipinos
places of shortage ○ 6340 killed
○ UTI was also prevalent in the elderlies → ● Typhoon Haiphong
inadequate resources ○ October 8, 1881
○ Too young and Too old: Diapers were used for ○ Pinakamalakas na typhoon sa northern luzon
the whole day due to lack of resources ○ Akala ng prayle magugunaw na ang mundo
○ Clothing specifically underwear and diapers ○ 20,000 killed
were given ○ Deadliest typhoon to ever hit the Philippines
○ Clean water is badly needed during this time ● Taal Volcano (1911)
● Cause large population movements (refugees) ○ Honorable mention
creating a burden on other health care systems and ● Mt. Pinatubo
communities ○ June 15, 1991
○ Ex: Refugees from ukraine and russia → burden ○ Honorable mention
to healthcare system ● Pandemic ng cholera (1902)
○ Ex. War in Russia, the nearby countries were ○ 116,000 reported cases
ready to help the refugees ○ 109, 461 killed
● Disasters frameworks for response are increasingly ○ Leading cause of death
shaped by ○ Apolinario Mabini dead
○ Globalization
○ Changing world dynamics TRIAGING
○ Social inequality Recording Link:
○ Sociodemographic trends ● Triaging
○ Trying to sort out
TOP 10 DEADLIEST NATURAL DISASTERS IN THE PHILIPPINES ○ Sorting out or prioritizing depending on the
needs
Top 10 Deadliest Disasters in Philippines
● Is triaging in the ER same with triaging in disaster
● Taal 1754 eruption areas?
○ 7 months eruption ○ Keypoint: Resources are limited in the disaster
○ 40 inches ash fall areas
○ Erupted again on 1911 ○ Black tag: allowed to die–dead people,
● Typhoon Hernan in Samar expectant
○ 1500 killed ■ Ex: people in war → they are allowed to
○ 10 million population in philippines die
○ 1897 ○ Ex. Who to prioritize? A person wherein the
● Typhoon Angela internal organs are already out or a person who
○ September 22, 1867 lost their hand and leg
○ Signal no. 5 ■ We prioritize the person who lost their
○ 300kph extremities
● Mount Hibok-hibok eruption ○ Prioritize those who can be saved
○ Poisonous gas, lava ● In disaster, save more lives due to the lack of
○ 19 km radius - affected area resources
○ 3000 people killed ○ Be of help to mass casualties
○ 69000 residentes migrated → only 34000
stayed MASS CASUALTY/DISASTER TRIAGE
● Moro Gulf earthquake (1967) TRIAGE UNDER MASS CASUALTY CONDITIONS
○ Magnitude 7.9 (DISASTER TRIAGE)
○ Felt from region 9 to 12 ● During disaster triage, we lack resources compared
○ 40,000 houses are destroyed to hospital triage because they have adequate
● Tropical Storm Thelma (Uring) resources
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● Disaster situation
○ # of casualties exceed US DEPT. OF HOMELAND SECURITY THREAT LEVELS
resource capabilities ● RED
● Emergent (Class I / red tag) ○ Severe; specified site
○ Airway compromise, ○ Actions
hemorrhagic shock ■ Lockdown security
■ ABC problems ■ No parking near site
that can be ■ Activation of “E” Operation Plan Incident
managed by Command System
different ● ORANGE
resources ○ High; risk of attack
● Urgent (Class II/ Yellow tag) ○ Specific site may not yet identified
○ Needs tx within 30 ○ Actions:
min-2 hrs ■ Up security and screenings
○ Open fractures, large wounds ■ Activation of Incident Command System
● Non Urgent (Class III / green tag) ● YELLOW
○ Tx delayed >2hrs ○ Elevated; possible risk
○ Closed fractures, sprain/strains, confusions, ○ No defined site
abrasions ○ Actions:
○ “Walking wounded” ■ Up awareness and monitoring of
● Expectant (Class IV / black tag) activities
○ Expected & allowed to die; dead ■ Continued training for “E” Operation Plan
○ Massive head trauma, high cervical SCI, ● BLUE
extensive burns ○ Guarded; general risk
■ Thus we need “exercise or drills”
OLD NEW SYSTEM MASS CASUALTY
○ No specific risks identified
(HOSPITAL) CONDITIONS ○ Actions:
(DISASTER) ■ Ensure readiness
● Ex: emergency plans, exit areas
Resuscitation ■ Drill practice
● Ex: earthquake drills in schools
Emergent Emergent Emergent ● GREEN
(immediate)
○ Low; little or NO risk perceived/ known
Urgent Urgent Urgent ○ Actions
(delayed) ■ Continued preparedness
Since they can ■ Drill practice
survive ● Ex: go bags at home

Non Urgent Non-urgent Non urgent

PSYCHOLOGICAL REACTIONS SECONDARY TO DISASTER
(minimal)
● Panic
Fast Track Minor Expectant ○ May cause chest pain, asthma, cardiac arrest
Allow to die ● Hysteria
● Despair
● Depression
DISASTER LEVELS
○ Losing lives, properties
● Level 1 ○ Prone to suicidal ideations
○ Local “E” response ○ Even after the war or disaster, depression may
○ Organizations contain & manage effectively the happen thus briefing may be needed in the
disaster & its aftermath families or communities
○ Ex. barangay
● Level 2 COMMON REACTIONS OF DISASTER SURVIVORS:
○ Regional efforts EMOTIONAL
■ Barangay efforts may not be enough ● Shock, feeling numb
○ Aid from surrounding communities sufficient to ● Fear
manage disaster’s efforts ● Grief, sadness
● Level 3 ● Anger
○ Local and regional assets overwhelmed ● Guilt, shame
○ Statewide/federal assistance required ● Feelings of helplessness
■ Whatever resources may be used ○ Apply psychiatric nursing management
■ Ex: ukraine and russia’s refugees → other ●
countries are helping them

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 ○ Ex: wearing PPE during suctioning, oral care, eye
COMMON REACTIONS OF DISASTER SURVIVORS: care
INTERPERSONAL ● Level B
● Distrust ○ Highest level respiratory
● Conflict ○ Lesser level of skin & eye
● Withdrawal protection required
● Work or school problems ■ Self contained breathing
● Irritability apparatus (SCBA)
● Loss of intimacy ■ Chemical resistant suit but
● Feeling rejected or abandoned not vapor tight
● Level C
COMMON REACTIONS OF DISASTER SURVIVORS: ○ Air purified respirator
COGNITIVE ○ Chemical resistant coveralls
● Confusion (disoriented) with splash hood, chemical
● Indecisiveness resistant gloves and boots
● Worry ● Level D
● Shortened attention span ○ Typical work uniform
● Trouble concentrating ■ Most often used in
○ Give them time and space. Do not rush them hospitals
○ Gradually compensate

COMMON REACTIONS OF DISASTER SURVIVORS:

PHYSICAL
● Tension, edginess
● Fatigue, insomnia
● Body aches, pain, nausea
● Easily startled
● Racing heartbeat
● Appetite changes
● Sexual drive changes
● Parents: Lack of energy to take care of their children
○ Apathetic
○ Children may not feel the same feeling; they
may be energetic still
● Inability to take care of themselves

TERMINOLOGY
● Personal protective equipment (PPE) COVERAGE OF QUIZ
○ PPE were used for 12 hours, they do not take it off ● First part of your quiz 1
since it is expensive ○ 40 items; 45 mins
○ They eat only twice during their duty: before ○ Randomized questions, no backtrack
○ 2nd device
they put their PPE and after they take it off since
○ Disaster nursing
this can cause self-contamination (from PPE to ■ Different sorting, triaging, places
other belongings) ■ Give scenario
● Level A ■ Nursing process, emergency nursing
○ Highest level of respiratory, management
skin, eye and mucous ● Drugs, PPE
membrane protection required
■ Self contained breathing
apparatus (SCBA)
■ Fully encapsulating,
vapor-tight, chemical
resistant suit
● Very hot when worn
especially in gov’t
hospitals, improvised
facilities outside the
hospital
● From head to toe suits
■ Chemical resistant gloves and boots
○ Ex: taking care of a pt with DELTA virus
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